A series of studies were conducted applying a negotiated approach to the conduct of the initial interview in a psychiatric walk-in clinic. One was on ventilation and mood change, another on the relationship of process measures of negotiation to outcome, and a third was on communication of suicidal ideation. In the ventilation study, of 108 patients, significant changes were found for POMS measures of tension, depression, anger, fatigue, and confusion. The patient's goal is not predominantly mood change. Patient satisfaction correlated more with being treated in a negotiated manner than in having a reduction in dysphoric mood. Change in dysphoric mood seemed to have a complex and generally weak relationship to the opportunity to ventilate feelings, the utilization of the negotiated approach, and requests for ventilation. In the process study of 59 audio tapes, conflicts or explicit differences between clinicians and patients over the nature or conditions of treatment was found to be a relatively infrequent event, occurring in 10% of the cases. And in cases of explicit difference, the general reaction of the clinician was negative, not to acknowledge or to explore the differences, not to make concessions. The clinician's pursuit of consensus over treatment, a measure sensitive to the recognition and resolution of unstated differences, was low or absent in 40% of the cases. A clinical reality appears to be that if there is agreement between the clinician and the patient, it is often unstated and untested, an undesireable state of affairs. The measures of the negotiated approach correlated better than warmth and empathy with patient evaluation measures. In a study of communication of suicidal ideation in 115 patients, two findings were salient: 1) a large number of patients admit to suicidal ideation (scores on the Symptom Checklist) but fail to communicate it to the clinician (no notation of ideation in the chart), and 2) the non-identified suicide ideators have requests that suggest seeking a dependent relationship with a strong authority figure.